A national health service paid for by taxes

Italy’s public system is the Servizio Sanitario Nazionale (SSN), set up by Law 833 of 1978. The Ministry of Health describes its founding principles as universality, equality and equity of access, and the service is funded through general taxation rather than the old mutual sickness funds, with the aim of covering the whole population.

Care is organised region by region. Each region runs its health service through local health authorities, the ASL, and enrolment and the health card are handled at that local level. Once enrolled, a person is placed on the ASL list and chooses a family doctor (medico di medicina generale), who is the first stop for other SSN services.

Deciding who employs the person

In Italy, supplying a worker to another business, known as somministrazione di lavoro, is reserved to employment agencies authorised by the Ministry of Labour and entered in its national register of agencies. That is the legal form an employer of record arrangement generally takes there, so a US company without an Italian entity would look for a licensed Italian agency, or a provider that works through one, before making the hire.

The local employer then runs Italian payroll, including contributions to INPS, the national social security institute, and enrols the employee in any sector health fund that applies. A genuine independent contractor working under their own VAT number (partita IVA) is a different case: ministry guidance indicates they enrol in the SSN on their own account. Treating someone as a contractor when the role looks like employment carries its own risks, which our guide to health coverage for EOR and contractors abroad outlines in general terms.

What the employer contributes, and where sector funds come in

Neither the employer nor the employee pays a separate health premium to the SSN, because the service is tax-funded. Employer social contributions to INPS still apply to Italian payroll and go toward items such as pensions and sickness pay; get the current rates from whoever runs the payroll.

No national law obliges every employer to buy private health cover. Instead, many national collective labour agreements (CCNL) create health funds for their sector. Trade press reported, for example, that under the metalworkers’ agreement, membership of that sector’s fund became automatic from 1 October 2017, paid for by the employer, with staff able to opt out in writing. Whether a given employee must be enrolled depends on which CCNL covers the job.

Supplementary cover and the tax exclusion

Supplementary health cover through employer funds and casse, called assistenza sanitaria integrativa, is a recognised part of Italian pay. Guidance from the Agenzia delle Entrate explains that, under article 51(2)(a) of the income tax code (TUIR), health contributions paid by the employer or the employee to funds or casse with an exclusively welfare purpose are left out of the employee’s taxable income up to a yearly limit.

Two conditions stand out. The contributions have to be provided for by a contract, an agreement or a company regulation, so an informal payment may not qualify. And a 2025 ruling from the tax agency confirmed that the exclusion also reaches contributions made for family members, including ones who are not tax dependants. Because the treatment turns on the plan documents, check it, along with the hiring route and the applicable sector agreement, with a local adviser or tax professional before setting up a benefit.

Can a plan from abroad stand in for the SSN?

For an employee with a work permit, ministry guidance points to no. It places foreign nationals holding a residence permit for employment (lavoro subordinato) in the group that must enrol in the SSN, with enrolment lasting as long as the permit. An international plan can therefore only sit on top of the public service, not take its place.

Who issues the policy matters as well. Insurers based in another EU or EEA state may operate in Italy under their home authorisation, through a branch or the freedom to provide services, and the insurance supervisor IVASS lists them. Insurers based outside the EU and EEA must set up an authorised establishment in Italy, and article 29 of the private insurance code bars them from selling there on a cross-border services basis.

Family, permits and short stays

According to the Ministry of Health, dependant family members who are lawfully resident share the worker’s SSN rights. To enrol, a non-EU worker goes to the ASL for their municipality of residence, or for the domicile shown on the permit if they are not yet resident, with the permit or renewal receipt, ID, tax code (codice fiscale) and a self-declaration of residence.

Gaps in paperwork are allowed for: the guidance says a worker waiting on a first permit or a renewal keeps SSN enrolment in the meantime. People outside the mandatory groups, such as some long-stay visitors, can enrol voluntarily for a yearly fee, although an employee does not need that route. On short stays, EU, EEA and Swiss nationals rely on their European health insurance card, known in Italy as TEAM.

Requesting an introduction for your Italian hire

For health cover, our role is to make an introduction: on request, we can connect you with a benefits partner that handles international and remote-team health coverage. Use the quote form on this page to tell us which Italian region the employee lives in, how many people you employ abroad, whether family members would be included and how the person is employed, and we will pass the details on. The partner and the insurer then work out eligibility, the plans on offer and their pricing.

If Italy is one of several hiring countries, the international health insurance overview lays out the options country by country, and the employee benefits hub gathers every benefits topic in one place.

A few useful answers

Common questions

Does a remote employee in Italy need a private health plan?

No national law requires employers to buy one. The SSN is tax-funded, and an employee with a work permit is in the group that must enrol. A sector collective agreement may still bring a health fund with the job.

Can a US company employ someone in Italy through an employer of record?

Supplying workers to another business is reserved to agencies authorised by the Ministry of Labour, so the arrangement needs a licensed Italian agency or a provider working through one.

Are health fund contributions taxed in Italy?

Contributions to funds or casse with an exclusively welfare purpose are left out of the employee’s taxable income up to a yearly limit, provided a contract, agreement or company regulation sets them up.

May a non-EU insurer write a policy for an employee in Italy?

It needs an authorised establishment in Italy. The private insurance code bars insurers from outside the EU and EEA from selling there on a cross-border services basis, while EU and EEA insurers may operate under their home authorisation.

Are an Italian employee’s family members covered?

Dependant family members who are lawfully resident share the worker’s SSN rights, according to the Ministry of Health.

International Health Insurance for Remote Employees in Italy